Case records and commentaries in Obstetrics and Gynaecology

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Abstract

To compare the clinical and histological diagnosis of adnexal masses excised
at Kenyatta National Hospital, Nairobi.
This was a descriptive cross-sectional study.
The mean age of the patients was 29.5 years with a range of 20-45 years, and
98.8% of the patients were literate. The mean age at menarche was 15.1 years and 71.6 %
had been sexually active by 18 years of age. There was no family history of any form of
cancer in 96.8% of the patients. The most commonly diagnosed adnexal mass by clinical
methods was ectopic pregnancy 59.3% and tubo-ovarian masses 24.7%. The main
complaint usually was lower abdominal pain alone 33.3%, or accompanied by vaginal
and/or urethral discharge 46.9%. In Intra-operative analysis, the most common diagnosis
was also found to be ectopic pregnancy 56.8% followed by benign cysts 19.8% and (non-
neoplastic) functional cysts 13.6%. The mass was noticed to be unilateral 86.4%, cystic
86.4%, freely mobile 71.6% and lacked ascites 9~8%.
The most important finding of this study was the histological diagnosis which confirmed
ectopic in pregnancy 49.4%, functional cysts comprised 25.9%. The other findings were
pelvic inflammatory disease 7.4%, serous cystadenoma 6.2%, fibroid 3.7% and serous
cystadenocarcinoma 1.2%.
Clinical diagnosis is important in detecting ectopic pregnancy confirmed by histological
diagnosis. Most of the adnexal masses were either non-neoplastic or benign. The
conclusive determination of other adnexal masses is not definitive and requires
physicians high index of suspicion whenever a complaint of lower abdominal pain is
raised. Ultrasound is a reliable pre-operative investigative tool.